252 Obstetrics and Gynecology Board Review •••
❍ The familial nature of endometriosis has been reported in case reports and retrospective reviews. Simpson
studied 123 patients with histologically demonstrated endometriosis. 5.9% of sisters and 8.1% of mothers
were also affected. However, when the patient’s husband’s family history was looked at, only 1% of sisters
and .8% of mothers had endometriosis. Propose a genetic mechanism for these findings.
It can be polygenetic inheritance or a single mutant autosomal dominant or autosomal recessive gene, or lastly, a
single mutant gene occurring in a small subset of patients with endometriosis. The most likely mode is polygenic
and multifactorial.
❍ Name one characteristic of endometriosis that histomorphologically separates it from eutopic endometrium.
Extensive stromal hemorrhage or dense stromal fibrosis.
❍ How is the immune system altered in patients with endometriosis?
Macrophages that typically clear aberrant cells have been noted to be permissive in patients with endometriosis.
In fact, cytokines and growth factors are secreted such that they promote endometriotic implants.
❍ Chronic progesterone therapy has what specific effect on endometriosis?
Initial decidualization of endometrial tissue with eventual atrophy.
❍ What is the currently accepted rate of transformation of endometriosis to malignancy?
<1%.
❍ Name at least three malignant neoplasms arising in endometriosis.
Clear cell adenocarcinoma, adenoacanthoma, adenosquamous carcinoma, leiomyosarcoma, endometrial stromal
sarcoma, mixed Mullerian tumor, or carcinosarcoma.
❍ You have seen a suspicious lesion at laparoscopy and biopsied the lesion. The pathology report indicates
endosalpingiosis. What does this mean?
The characteristics of the cells and stroma of the epithelial cells and the stroma of the biopsy specimen indicate
tubal-type epithelium. Involvement of the canal of Nuck with endometriosis indicates the presence of a hernial
sack of hydrocele to provide communication with the peritoneal cavity.
❍ Endometriosis of the cervix is well known. It usually is a result of cervical trauma. In retrospective study,
what percentage of cases are associated with trauma?
90%.
❍ With what tumor is endometriosis of the appendix associated with?
Mucinous carcinoid.
❍ What is a catamenial pneumothorax?
This is a rare condition that often involves endometriosis of the diaphragm, causing the lung to collapse during
menses.
❍ Catamenial pneumothorax is associated with endometriosis what percentage of the time?
25%.